An article in today’s New York Times discusses the report released yesterday by the National Center for Health Statistics (NCHS) on the continued rise in cesareans. The article quotes Dr. George A. Macones:
The continuing rise “is not going to be good for anybody,” said Dr. George A. Macones, the chairman of obstetrics and gynecology at Washington University in St. Louis and a spokesman for the American College of Obstetricians and Gynecologists. “What we’re worried about is, the Caesarean section rate is going up, but we’re not improving the health of babies being delivered or of moms.”
Macones goes on to cite fear of malpractice suits as a significant driver of cesareans for many OBs:
“The threshold for doing a Caesarean section is going down, and one of the major factors is professional liability, ending up in court,” Dr. Macones said.
In an article last month in the journal Obstetrics and Gynecology, the obstetricians’ college reported that a poll of 5,644 of its members found that 29 percent said they were performing more Caesareans because they feared lawsuits. Eight percent said they had quit delivering babies, and nearly a third of those said it was because of liability issues.
The declining trend of VBAC is also noted.
An expert panel convened earlier this month by the National Institutes of Health said there were too many barriers to vaginal birth after a Caesarean and suggested ways to reduce them. It urged the obstetricians’ group to reassess its guidelines on “immediate availability,” and it urged hospitals to publicize their rates of vaginal birth after a Caesarean, so women could make informed choices about where to give birth. It also acknowledged the problem of malpractice suits but did not make a specific recommendation about how to solve it.
Dr. Macones said the panel’s advice made sense, but he added: “The first thing we should be trying to do is lower the primary C-section rate. Then we wouldn’t get into this trouble.”
Unfortunately, Dr. Macones also perpetuates the myth that maternal request for cesareans is a key factor. However, research shows that the percentage of true maternal request cesareans is very low – less than 1%.
Even so, it seems that even ACOG can no longer ignore the fact that the rising cesarean rate is not producing better outcomes for mothers and babies. As ICAN President Desirre Andrews notes in ICAN’s press release on the report:
“This report confirms the alarming trend affecting all age and ethnic groups of childbearing women,” said Desirre Andrews, President of ICAN. “With every state showing an increase of cesarean deliveries, this concerns all women across the United States today.”
3 Responses
INTERESTING that ACOG decided to make Dr. Macones a spokesperson! He is an author of one of the pro-vbac, anti-c-surgery articles that was considered by the NIH panel and the AHRQ study. Sounds like they are trying to at least sound like they are “getting religion” on this issue, even if they’re hardly ready yet to join us here in the choir.
A family practice doc who provides OB services, who was at the NIH conference, and whom I trust, told me the other day that ACOG is, indeed, going to be changing the vbac guidelines. The American Association of Family Physicians, which already had better guidelines than ACOG, is going to also reassess and revise in response to the NIH conference and report.
And this morning, The Daily Beast blogged about maternal death and rising c-section rates. This is a mainstream blog, and very popular, so the message is totally getting out into the public eye and ear, where it needs to be. Dear Friends and Allies, I think the C-section/vbac issues have “tipped.” Anyone agree?